Ventilator circuit and method for the use thereof

ABSTRACT

A ventilator circuit for use in administering medication to a patient includes a housing, a one-way inhalation valve and a one-way exhalation valve. A metered does inhaler receptacle is in fluid flow communication with an interior space of the housing holding chamber. An exhaust conduit communicates between input and output passageways disposed on opposite sides of the interior space.

This application is a continuation of U.S. application Ser. No.11/410,270, filed Apr. 24, 2006, which claims the benefit of U.S.Provisional Application No. 60/675,944, filed Apr. 28, 2005, the entiredisclosures of which are hereby incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates generally to a ventilator circuit, and inparticular, to a ventilator circuit having inhalation and exhalationvalves.

BACKGROUND

Patients have certain conditions that can be treated with medicamentsdispensed in an aerosol and administered to the patient by inhalation.In one format, the aerosol and medicaments are contained in a container,and dispensed in metered, or measured, dosages with an inhalationdevice. For example, as shown in U.S. Pat. No. 6,435,177, entitledAEROSOL MEDICATION DELIVERY APPARATUS AND SYSTEM, and assigned toTrudell Medical International, the same Assignee as the presentapplication, a holding chamber can be used to facilitate theadministration of the medication to a patient. Typically, when used in aventilation circuit, the holding chamber is introduced into theventilation circuit just prior to the administration of the medicationand is then removed.

SUMMARY

In one aspect, a ventilator chamber, for use in a ventilator circuitthat administers medication to a patient, includes a housing, a one-wayinhalation valve and a one-way exhalation valve. The housing includes achamber defining an interior space having an input opening and an outputopening, an input port defining an input passageway communicating withthe input opening and adapted to receive a flow of gases from aventilator intake line, a pressurized metered dose inhaler receptacle influid flow communication with the interior space, an output portdefining an output passageway and communicating with the output opening;and an exhaust conduit communicating between the output passageway andthe input passageway of the output port and said input portrespectively. The one-way inhalation valve is positioned to permitone-way flow from the input passageway of the input port to the interiorspace of the chamber housing. The one-way exhaust valve is located inthe exhaust conduit and is adapted to prevent a backflow of gas from theexhaust conduit into the output passageway.

In one embodiment, the input port and the output port are oriented in asubstantially non-parallel relationship. In one embodiment, the inputport and the output port are oriented in a substantially perpendicularrelationship. This relationship allows for better positioning of theapparatus relative to the ventilator and patient.

In another aspect, a ventilator circuit for administering medication toa patient includes the chamber housing. The exhaust conduit opensdirectly into the input passageway at an exhaust opening formed in theinput port. The one-way inhalation valve is positioned downstream fromthe exhaust opening. The one-way exhaust valve is located in the exhaustconduit and is adapted to prevent a backflow of gas from said exhaustconduit into said output passageway.

In another aspect, ventilator circuit includes a chamber housingdefining an interior space, a one-way inhalation valve operative topermit a flow of gases into an interior space of said chamber housing,an inhalation conduit communicating with an output end of a chamber andan exhaust conduit communicating with the inhalation conduit. Theexhaust conduit includes a viewing window, which permits the user orcaregiver to monitor the patient's breathing cycle. A one-way exhaustvalve is located in the exhaust conduit and is adapted to prevent abackflow of gas from the exhaust conduit into the inhalation conduit. Atleast a portion of the one-way exhaust valve is visible through theviewing window of the exhaust conduit.

In another aspect, a medication delivery device includes a holdingchamber having an input end and an output end and a metered dose inhalerreceptacle in communication with the input end of the holding chamber.The receptacle includes at least first and second wells shaped toreceive respectively a valve stem of first and second metered doseinhalers. The first and second or orifices may have two different shapesrespectively if two different medications are being used.

In yet another aspect, a method of assembling a ventilator chamber foruse in a ventilator circuit includes providing a first chamber componentdefining at least a portion of a chamber, at least a portion of an inputport and at least a portion of an exhaust conduit, providing a secondchamber component defining at least a portion of the chamber, at least aportion of an output port and at least a portion of the exhaust conduitand providing a connector component defining at least a portion of theexhaust conduit. The method further includes disposing the connectorcomponent between the first and second chamber components and connectingthe first and second chamber components.

In yet another aspect, a method of administering a medication to apatient includes transmitting oxygen from a gas source through an inletline, a holding chamber and an inhalation conduit to the patient duringan inhalation sequence of a breathing cycle. The method further includesintroducing medication into the holding chamber, preventing asubstantial transmission of an exhaust gas into the holding chamberduring an exhalation sequence of the breathing cycle, and transmitting asubstantial portion of the exhaust gas into an exhaust conduit duringthe exhalation sequence. The method further includes preventing asubstantial transmission of the exhaust gas from the exhaust conduitinto the inhalation conduit during subsequent inhalation sequences ofsubsequent breathing cycles, and transmitting the exhaust gas from theexhaust conduit directly into the inlet line.

The various embodiments and aspects provide significant advantages overother ventilator circuits. In particular, the inhalation valve creates aback pressure, which prevents a substantial portion of an exhaust gasfrom entering the chamber. In addition, the exhaust valve also operatesto prevent the exhaust gases from reentering the inhalation conduit fromthe exhalation conduit. In this way, the chamber can remain in theventilator circuit even when not being used to administer a medication.

In addition, in one embodiment, the housing, with its integrated inputport, output port and exhaust conduit, can be easily manufactured andinstalled in the ventilator circuit without the need for an additionalexhaust tube or connector. Likewise, the three-piece housing, with itsthree components, can be easily assembled. In addition, the orientationof the input and output ports are perpendicular to allow for thepositioning of the ventilator circuit beside the patient and to connectthe ventilator circuit to the endotracheal tube without the need for anelbow connector.

The metered dose inhaler receptacle also provides advantages with itstwo wells. For example, the same chamber can be used with differentmedicament containers and formulations without having to remove thechamber from the circuit.

The foregoing paragraphs have been provided by way of generalintroduction, and are not intended to limit the scope of the followingclaims. The presently preferred embodiments, together with furtheradvantages, will be best understood by reference to the followingdetailed description taken in conjunction with the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a top view of one embodiment of a ventilator chamber.

FIG. 2 is a perspective view of the ventilator chamber shown in FIG. 1.

FIG. 3 is an exploded view of the ventilator chamber shown in FIG. 1.

FIG. 4 is a top, cross-sectional view of the ventilator chamber shown inFIG. 1 during an inhalation sequence of a breathing cycle.

FIG. 5 is a top, cross-sectional view of the ventilator chamber shown inFIG. 1 during an exhalation sequence of a breathing cycle.

FIG. 6 is a perspective view of a portion of a ventilator circuit.

FIG. 7 is a perspective view of a connector component.

FIG. 8 is a top view of an alternative embodiment of a ventilatorchamber.

FIG. 9 is an exploded perspective view of the ventilator chamber shownin FIG. 8.

FIG. 10 is a top view of another alternative embodiment of a ventilatorchamber.

FIG. 11 is a perspective view of the ventilator chamber shown in FIG.10.

FIG. 12 is an exploded view of the ventilator chamber shown in FIG. 10.

FIG. 13 is a perspective view of another alternative embodiment of aventilator chamber.

FIG. 14 is a cross-sectional view of the ventilator chamber shown inFIG. 13.

FIG. 15 is an end view of the output component of the ventilator chambershown in FIG. 13.

DETAILED DESCRIPTION OF THE PRESENTLY PREFERRED EMBODIMENTS

Referring to FIGS. 1-6, a ventilator circuit 2 is shown as having aventilator chamber 4 positioned in the inspiratory flow path from theventilator 14 to the patient. The ventilator chamber 4 includes ahousing 16 having a holding chamber 12 defining an interior space 6, aninput opening 8 and an output opening 10. In one embodiment configuredfor an adult, the holding chamber 12, and in particular the interiorspace 6, preferably has a volume of between about 50 ml and 250 ml, morepreferably between about 60 ml and 100 ml, and most preferably about 85ml, although other volumes not specifically enumerated herein aresuitable. In an alternative embodiment configured for an infant, childor younger patient, the volume of the interior space is between about 20and 60 ml, and preferably about 35 ml.

Preferably, the holding chamber 12 is made of a clear plastic, althoughit can be non-transparent in certain embodiments. Various aspects of theholding chamber are further disclosed and described in U.S. Pat. No.6,435,177, which is hereby incorporated herein by reference in itsentirety. In one embodiment, the holding chamber is made from ananti-static material, as disclosed for example and without limitation inU.S. patent application Ser. No. 10/821,260, filed Apr. 8, 2004, whichis hereby incorporated herein by reference in its entirety. In oneembodiment, the holding chamber is antistatic, meaning it has a surfaceresistivity of less than about 10E12 ohm/sq., and preferably betweenabout 10E10 and about 10E12 ohm/sq. Preferably the anti-static holdingchamber is made of plastic. The holding chamber 12 has a one-wayinhalation valve 18 positioned upstream of the interior space 6, and aone-way exhaust valve 20 positioned downstream of the interior space 6.As used herein, “upstream” and “downstream” refer to the direction ofthe flow of gases during the inhalation sequence of a breathing cycle.As used herein, the terms “exhaust” and “exhalation” areinterchangeable.

The ventilator circuit further includes a ventilator intake line 26,which forms part of an inhalation conduit that runs between theventilator and the holding chamber. The intake line 26 carries oxygenfrom the ventilator 14 to a Y-connector 24, which is also connected toan exhaust line 22. The Y-connector 24 also is connected to an input end28 of an input port 30 of the ventilator housing. The input port definesan input passageway 32 in communication with the input opening 8 of thehousing chamber. The terms “communicate,” “communicates,”“communication,” and variations thereof, refer to the conveyance of afluid, e.g., liquid or gas, between two components or locations, whetherdirectly or indirectly, for example by way of another component.

The housing further includes an output port 34 having an outputpassageway 36 in communication with the output opening 10 of the holdingchamber 12. As shown in FIGS. 1-6, the input port 34 and output port 30,and the respective input and output passageways 28, 34, each defined byaxes 38, 40 respectively, are configured in a non-parallel relationship,and in one embodiment in a substantially perpendicular relationship.

In various embodiments, the output port 34 of the ventilator chamber canbe configured with a narrow orifice in the output passageway, asdisclosed for example in U.S. Provisional patent application Ser. No.10/979,743, filed Nov. 2, 2004 and entitled AEROSOL MEDICATION DELIVERYAPPARATUS WITH NARROW ORIFICE, which is hereby incorporated by referenceherein. In one embodiment, the narrow orifice is formed integrally inthe output port. In another embodiment, the narrow orifice is formed inan adapter secured to the ventilation chamber 4. The narrow orifice,when formed for example in an adapter, is positioned between the outputport 34 and a user interface element (not shown) connected thereto. Inone exemplary embodiment, the narrow orifice has a cross-sectional areaof less than about 60 mm².

The output port 34 has an end portion 42 configured to mate with apatient or user interface element, configured for example as a mask,mouthpiece or endotracheal tube. The patient interface element completesthe inhalation conduit. The patient interface element preferablyincludes an end portion configured to be disposed in or around the endportion 42 of the output port. Alternatively, the patient interfaceelement can be integrally formed with the output port.

The housing further includes an exhalation conduit 44 that extendsbetween and is connected to the input and output ports 30, 34. Theexhalation conduit defines a passageway 46 that communicates with theinput and output passageways 32, 36. In one embodiment, the exhaustconduit passageway 46 opens directly into the input passageway throughan exhaust opening.

A pressurized metered dose inhaler (MDI) receptacle 50 is formed on atop of the housing 16. The receptacle 50 defines a socket or recess 52shaped to receive the end portion of a medicament container 58 and awell 54 formed in the bottom of the recess. The well 54 is shaped toreceive and frictionally engage a valve stem 60 extending from the endof the container. The well 54 communicates with an orifice 56, whichopens into the interior space of the chamber. In one embodiment, thewell 54 and orifice 56 are defined by a discharge nozzle 62, which isremovably secured in the bottom of the receptacle. An arm or locatormember extends from the nozzle to ensure the proper orientation of thenozzle and also to prevent the inhalation valve from dislodging andentering into the inhalation tube leading to the patient. Since thenozzle is removeable in one embodiment, different nozzles can beexchanged and used with the same ventilation chamber 4, even withouthaving to remove the ventilation chamber 4 from the ventilator circuit2. It should be understood that the receptacle can be configured toconnect to and support medication containers or systems other than thedisclosed MDI.

Referring to the embodiment of FIGS. 8 and 9, the discharge nozzle 64has a plurality (meaning more than one) of wells 54, 66 and respectiveorifices 56, 68. The recess 5 and nozzle have an obround shape, roundedat opposite ends to accommodate a container in each well. In oneembodiment, the wells are spaced such that the containers can be mountedsimultaneously in tandem, while in another embodiment they must bemounted sequentially. In the illustrated embodiment, the nozzle has afirst and second well 54, 66. The wells 54, 66 communicate withrespective orifices 56, 68, which have different shapes. The differentorifices accommodate different types of medication. In particular, thesize of the orifice will influence the size of the aerosol particle. Forcertain medications targeted for the deep part of the lungs, a particlesize of about 4.7 microns is desirable. Other medications target theupper part of the lungs, and may therefore have a particle sizedesirably greater than 4.7 microns. In one embodiment, a first orificeis about 11 microns, suitable for example and without limitation forcorticosteroid medication, and the second orifice is about 14 microns,suitable for example and without limitation for bronchodilatormedication.

It should be understood that the wells can also have a different shapetop accommodate different shapes of valve stems. It should be understoodthat the wells can have the same shape, with the orifices beingconfigured differently for different formulations, that the orifices canhave the same shape with the wells having a different shape, or withboth the orifices and wells having a different shape. It should beunderstood that the phrase “different shape” means a differentcross-sectional configuration, for example and without limitationcircular or polygonal, or a different cross-sectional area, for exampleand without limitation circular orifices having different diameters.

In the embodiments of FIGS. 1-6, 8 and 9, the orifice(s) 56, 68 ispositioned adjacent or proximate the input opening 8 and opens in adownstream direction 72 into the interior space 6 of the holdingchamber. Alternatively, as shown in FIGS. 10-12, the MDI receptacle ispositioned adjacent or proximate the output opening 10, with the orificeopening or directed in the upstream direction 74 into the interior space6 of the chamber.

As shown in FIGS. 1-11, the ventilator chamber preferably includes threecomponents 76, 78, 80. A first component 76 forms and defines the inputport 30, a portion 82 of the holding chamber (and interior spacethereof) and a portion 86 of the exhalation conduit. A second component78 forms and defines the output port 34, a portion 84 of the holdingchamber (and interior space thereof) and a portion 88 of the exhalationconduit. As shown in the respective embodiments of FIGS. 1-7 and 9-11,the MDI receptacle 50 can be configured or formed on either the first orsecond component 76, 78. In another embodiment (not shown), both thefirst and second components have a MDI receptacle formed thereon.

A third component 80, or connector component, defines in part theexhalation conduit 44. The connector component 80 extends betweenexhaust openings 90, 92 formed in the first and second componentsrespectively. In one embodiment, the connector component 80 ispreferably clear or see-through, and defines a viewing window in theexhalation conduit. The connector component is generally cylindrical innature and has opposite ends 94, 96. Each end includes an annular orcircumferential groove 98 formed around the periphery of the connectortube. An O-ring, or other seal member 100, is disposed in each groove 98and mates with the interior surface of exhaust sockets 102, 104 formedin the first and second components. In this way, the seal members 100prevent any gases from escaping from the exhaust conduit 44 to theambient environment.

Referring to FIGS. 4 and 7, the connector component 80 includes aninternal wall 106 forming a valve seat. One or more openings 108 areformed in the wall to permit passage of gases through the wall. Aone-way exhalation valve member 20, shown as a center post valve issecured to a downstream side of the wall 106, with the valve coveringthe openings 108 when in a normal, closed position. The valve member 20is preferably colored, for example a bright color, such that it iseasily visible through the viewing window 114 of the connector component80. The spherical shape of the viewing window 114 magnifies theappearance of the valve member 20.

A wall or valve seat 110 is also formed in the input opening of thehousing chamber between the housing chamber and the input port. Again,one or more openings 112 are formed in the wall 110 to permit the flowof gases from the input passageway into the interior space of thechamber. A one-way inhalation valve member, for example a center postvalve member 18, is secured to the downstream side of the wall 110 andcovers the openings 112 when in a normal, at closed position. In otherembodiments, the inhalation and exhalation valves can be configured as aduckbill valve, or other known one-way valves.

In operation, and referring to FIGS. 4 and 5, during the inhalationsequence of a breathing cycle, the ventilator 14 introduces or transmitsoxygen from a gas source through the intake line 26, input passagewayand one-way inhalation valve, defined in one embodiment by the valvemember 18 and valve seat 110. A user, such as a doctor or nurse,actuates the medicament container 58 by depressing the container towardsthe receptacle 50, which releases a metered dose of medicament into theinterior space 6 of the holding chamber 12. The medicament travels withthe oxygen through the output opening 10 of the holding chamber andthrough the inhalation conduit, formed at least in part by the outputpassageway 36 in the outlet port 34 and the patient interface element.

During the exhalation sequence of the breathing cycle, exhaust gases areexpelled from the lungs through the patient interface element back intothe output port 34. Since the one-way inhalation valve, including in oneembodiment the valve member 18 and valve seat 110 positioned upstream ofthe output port 34, prevents the flow of gases back into the input port30, the one-way inhalation valve creates a back pressure in the holdingchamber 12, thereby preventing a substantial amount of exhaust gasesfrom entering the holding chamber 12. Instead, a substantial amount ofthe exhaust gases are transmitted through the exhaust conduit 44 pastthe one-way exhalation valve, formed in one embodiment by the valvemember 20 and valve seat 106. As the gases pass the one-way exhalationvalve, the user or care-giver monitors the viewing window 114 todetermine whether the valve member 20 is moving, thereby confirming thatthe system is working properly. The exhaust gases pass through theexhaust conduit 44 through the exhaust opening 48 into the inputpassageway 32 formed by the input port. The gases then travel throughthe Y-connector 24 and into the exhaust line 22 to the ventilator. Uponthe next inhalation sequence of the breathing cycle, the one-wayexhalation valve 20, 110 prevents the exhaust gases in the exhaustconduit 44 positioned downstream from the one-way exhaust valve 20, 110from reentering the inhalation conduit, including the output passageway36. By introducing the exhaust gases into the input passageway 32, thehumidity of the exhaust gases is deposited at the connection point 28 toa humidifier filter exchanger thereby humidifying the dry gas flowcoming from the intake line 26 and ventilator 14. In this way, therelatively short exhalation conduit 44, which is integrated into theventilator chamber 4, shortens the distance the exhaust gases have totravel and thereby increase the level of humidity at the input side ofthe housing.

A gas analyzer, shown for example in U.S. Pat. No. 5,693,944, which ishereby incorporated herein by reference, can be connected to the exhaustline or Y-connector to monitor the amount of CO2 gas or other gases areflowing through the conduit. A pressure line port 118 can also beconnected to the Y-connector to monitor the gas pressure in the circuitto avoid any increase in pressure due to an obstruction in the system,for example and without limitation.

Preferably, the ventilation chamber housing components 76, 78, 80 aremade of a hard plastic, including for example and without limitationABS, polypropylene, polyethylene, metal or PVC. Preferably, the valvemembers are made of a flexible material, including for example andwithout limitation polypropylene, polyethylene, silicone, thermoplasticelastomers, EPDM, and rubber. Various aspects of the ventilator circuitand components are disclosed and shown in U.S. patent application Ser.No. 10/774,751, filed Feb. 9, 2004, the entire disclosure of which ishereby incorporated herein by reference.

One of the first and/or second components 76, 78 has a peripheral flange116 or step that mates with the other component as the third component80 is sandwiched between the first and second components 76, 78. Thefirst and second components can be bonded, or otherwise connected forexample by welding, snap-fit, or other known devices. The receptacle ispreferably integrally molded with one or the other (or both) of thefirst and second components 76, 78.

Referring to FIGS. 13-15, a four-piece ventilator chamber 120 is shown.An input port component 122 is connected to an input end of a holdingchamber component 124. In one embodiment, the holding chamber is formedfrom two pieces 126, 128, with the MDI receptacle positioned on one ofthe holding chamber components. The components 126, 128 are snap-fittogether with a circumferential ring 152 that fits in a correspondinggroove 154. A discharge nozzle 130 extends into an input passageway 32and includes an orifice 56 facing downstream. The input component 122has an exhaust opening communicating with the input passageway.

An output port 132 is connected to the output end 134 of the holdingchamber. The output end includes a wall 138 having one or more openings140 formed therethrough. The wall defines a valve seat for a one-wayinhalation valve. The valve member 18 is connected to the wall on thedownstream side thereof. The output port 132 has a baffle formed thereinto prevent the valve member 18 from becoming dislodged and making itsway to the patient, and is shown in one embodiment as a three arms 136.The baffle includes an arm portion extending upstream to prevent thevalve dislodgement.

An exhaust conduit 142 communicates with the output passageway and has awall 144 formed at a junction thereof. The wall has one or more openings146 formed therein to permit the passage of gases through the wall. Thewall defines in part a valve seat. A one-way exhalation valve member 20is connected to the valve seat downstream therefrom. A tubular exhaustline 148, separate from or integral with, one or both of the input andoutput ports 122, 132 connects the ports and completes the exhaustconduit.

In operation, the ventilator chamber 120 operates in the same way as theembodiments shown in FIGS. 1-12. In particular, the one-way inhalationvalve 138, 18 permits only one-way flow of gas and medicament to thepatient, while the one-way exhalation valve 144, 20 prevents exhaustgases from reentering the inhalation conduit downstream of the holdingchamber 124. In the embodiment of FIGS. 13-15, however, the one-wayinhalation valve 138, 18 is positioned downstream of the holding chamber124, rather than upstream thereof. In addition, the exhaust conduitcommunicates directly with the input passageway and thereby providespassive humidification of the input gases entering the holding chamber.

Although the present invention has been described with reference topreferred embodiments, those skilled in the art will recognize thatchanges may be made in form and detail without departing from the spiritand scope of the invention. As such, it is intended that the foregoingdetailed description be regarded as illustrative rather than limitingand that it is the appended claims, including all equivalents thereof,which are intended to define the scope of the invention.

1-24. (canceled)
 25. An adaptor for delivering an aerosolized medicamentto a patient with concurrent ventilation comprising: a chamber definingan interior space and having a patient interface output port and aventilator gas input port, wherein said patient interface output portcommunicates with said interior space at a first location and saidventilator gas input port communicates with said interior space at asecond location positioned upstream from said first location, andwherein said ventilator gas input port and said patient interface portdefine non-coaxial axes; and an aerosol flow channel having an inletport separate from said ventilator gas input port and an outlet port incommunication with said interior space of said chamber at a thirdlocation positioned upstream from said first location and downstreamfrom said second location, and wherein said outlet port opens into saidinterior space in a downstream flow direction away from said ventilatorgas input port and toward said patient interface output port.
 26. Theadaptor of claim 25 wherein a ventilator gas flow path between saidventilator gas input port and said patient interface output port atleast partially encircles said aerosol flow channel.
 27. The adaptor ofclaim 26 wherein said aerosol flow channel is defined at least in partby a curved wall extending into said interior space of said chamber. 28.The adaptor of claim 25 further comprising a valve operable to releasean aerosol flow into said aerosol flow channel.
 29. The adaptor of claim25 further comprising a patient interface element coupled to saidpatient interface port.
 30. The adaptor of claim 29 wherein said patientinterface element comprises an endotracheal tube.
 31. An adaptor fordelivering an aerosolized medicament to a patient with concurrentventilation comprising: a chamber defining an interior space and havinga patient interface output port and a ventilator gas input port, whereinsaid patient interface output port communicates with said interior spaceat a first location and said ventilator gas input port communicates withsaid interior space at a second location positioned upstream from saidfirst location, and wherein said chamber defines a ventilator gas flowpath between said ventilator gas input port and said patient interfaceoutput port; and an aerosol flow channel having an inlet port separatefrom said ventilator gas input port and an outlet port in communicationwith said interior space of said chamber, wherein said aerosol flowchannel is defined at least in part by a curved wall, wherein saidventilator gas flow path at least partially encircles said curved wallof said aerosol flow channel.
 32. The adaptor of claim 31 furthercomprising a valve operable to release an aerosol flow into said aerosolflow channel.
 33. The adaptor of claim 31 further comprising a patientinterface element coupled to said patient interface port.
 34. Theadaptor of claim 33 wherein said patient interface element comprises anendotracheal tube.
 35. The adaptor of claim 31 wherein said ventilatorgas input port and said patient interface port define non-coaxial axes.36. The adaptor of claim 31 wherein said aerosol flow channel comprisesa nozzle extending into said interior chamber along an axissubstantially perpendicular to said ventilator gas input port.
 37. Aventilator circuit comprising: a ventilator gas source; a chamberdefining an interior space and having a patient interface output portand a ventilator gas input port, wherein said patient interface outputport communicates with said interior space at a first location and saidventilator gas input port communicates with said interior space at asecond location positioned upstream from said first location, andwherein said ventilator gas input port and said patient interface portdefine non-coaxial axes, and an aerosol flow channel having an inletport separate from said ventilator gas input port and an outlet port incommunication with said interior space of said chamber at a thirdlocation positioned upstream from said first location and downstreamfrom said second location, and wherein said outlet port opens into saidinterior space in a downstream flow direction away from said ventilatorgas input port and toward said patient interface output port; aventilator gas input line coupled between said ventilator gas source andsaid ventilator gas input port; and an aerosolized medicament sourcecommunicating with said aerosol flow channel.
 38. The ventilator circuitof claim 37 wherein said aerosolized medicament source comprises apressurized metered dose inhaler.
 39. The ventilator circuit of claim 37wherein a ventilator gas flow path between said ventilator gas inputport and said patient interface output port at least partially encirclessaid aerosol flow channel.
 40. The ventilator circuit of claim 39wherein said aerosol flow channel is defined at least in part by acurved wall extending into said interior space of said chamber.
 41. Theventilator circuit of claim 37 further comprising a valve operable torelease an aerosolized medicament flow from said aerosolized medicamentsource into said aerosol flow channel.
 42. The ventilator circuit ofclaim 37 further comprising a patient interface element coupled to saidpatient interface port.
 43. The ventilator circuit of claim 42 whereinsaid patient interface element comprises an endotracheal tube.
 44. Amethod for delivering an aerosolized medicament to a ventilated patientcomprising: transmitting a ventilator gas from a ventilator gas sourceto a ventilator input port of a chamber, wherein said input port definesa first axis; introducing an aerosolized medicament to said chamberthrough an aerosol flow channel having an inlet port spaced apart from,and positioned downstream from, said ventilator input port; at leastpartially encircling said aerosol flow channel with said ventilator gas;entraining said aerosolized medicament with said ventilator gasdownstream from said input port; and transmitting said aerosolizedmedicament and ventilator gas through a patient interface port of saidchamber to a patient interface element, wherein said patient interfaceport defines a second axis, wherein said first and second axes arenon-coaxial.
 45. The method of claim 44 wherein said first and secondaxes are substantially perpendicular.
 46. The method of claim 44 whereinsaid aerosol flow channel is defined at least in part by a curved wallextending into an interior space of said chamber.
 47. The method ofclaim 44 wherein said introducing said aerosolized medicament to saidchamber comprises opening a valve and thereby releasing an aerosol flowinto said aerosol flow channel.
 48. The method of claim 44 said patientinterface element comprises an endotracheal tube.